ArticleCureus2025
A Quality Improvement Project to Improve Syncope Care Through Structured Triage and Risk Stratification (STARS).
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
3 authors.
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Abstract
Background Syncope is a common emergency presentation, with causes ranging from benign reflex syncope to high-risk cardiac conditions. The 2018 European Society of Cardiology (ESC) Guidelines recommend structured risk stratification to guide admission and telemetry, but real-world adherence remains inconsistent. Objective This Quality Improvement Project (QIP) evaluated the impact of a structured Syncope Risk Stratification Chart (SRSC) and targeted education on guideline adherence, clinical assessment, and resource use in our Emergency Department and Medical Admissions Unit (MAU). Methods We conducted a retrospective review of syncope admissions (n=100, April-June 2024), followed by interventions (SRSC dissemination, staff education, visual prompts). A prospective re-audit (n=29, May-June 2025) assessed documentation of lying/standing blood pressure (LSBP) and family history (FH), admission rates, and telemetry use. Results In Round 1, admission rates differed significantly by ESC risk group (81% low-risk, 96% medium-risk, 100% high-risk; χ²(2, N=100) = 9.84, p = 0.007). In Round 2, rates were 89%, 89%, and 100%, with no significant differences (χ²(2, N=29) = 1.31, p = 0.52). Overall admissions were unchanged (92% vs 93%, p = 1.00). Telemetry allocation remained inconsistent (R1: 17%, 71%, 71%; R2: 38%, 88%, 91%), with between-round differences not statistically significant. Documentation improved, with LSBP recording increasing from 59% to 72% (p = 0.27) and FH assessment from 15% to 41% (p = 0.005). Conclusion Implementation of the SRSC and education significantly improved family history documentation and modestly improved LSBP recording. However, admission and telemetry practices remained misaligned with ESC recommendations. Sustained system-level strategies, senior triage input, and integration of decision-support tools are needed to achieve consistent, guideline-based syncope care.
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